Screening for Brain Injury

Before You Screen

Screening a survivor of IPV for a brain injury may have unintended consequences, or create potential risks, for that individual. Before starting the screening process, it is important for front-line workers to be aware of these risks, so that they can openly discuss them with their clients and make plans to minimize their impact. If, however, a client is not comfortable engaging in the screening process, their wish to opt out should be respected.

Abuser Manipulation

One of the hallmarks of abusive behaviour is manipulation for the purpose of gaining power and control. Abusive individuals are often looking for signs of perceived weakness or vulnerability in those that they abuse. They will use these vulnerabilities against those they abuse to gain power and control. In this way, an abuser may use the knowledge of a client’s brain injury to belittle her, undermine her parenting or life skills, or call into question her ability to live independently.

Systems & Structures

Survivors of IPV often experience challenges within the legal and justice systems. If they have children, they may also have child protective services involvement. It is important for women dealing with custody and access issues, or working with child protective services around safe parenting, to be aware of the risk that information about her brain injury could be misinterpreted. Abusers are often looking for ways to discredit the survivor in these arenas, and there is a risk that knowledge of their brain injury could be taken out of its proper context and be used to limit her access to her children.

Minimizing Risks

• Encourage your client to see herself as the owner and gatekeeper of any information about her brain injury.
• Help her make a list of people she feels are safe to discuss her brain injury with, and those she does not.
• Ensure that doctors and professionals involved in her care understand the unique complexities that come with being a survivor of IPV, and the high degree of vigilance necessary to keep her information confidential.
• Support her in educating those around her about brain injury, and to combat any stigma that may arise.
• Help her to find advocates who can accompany her to court proceedings and child services meetings, and speak up if information about her brain injury is used against her. If possible, offer to be that advocate in her life.
• Ask her if she needs accommodations such as information in writing, large print, or more time to respond to questions
• Ensure that resources for referral are present is a brain injury is disclosed

Content courtesy of Candace Stretch, The Cridge Supportive Housing & Family Services

Screening Tools

At this time, there are no validated tools to screen for brain injury in survivors of IPV. Generic screening tools exist and are sometimes used to identify individuals who may have an IPV-related brain injury. However, these tools have mostly been tested on young, healthy males with a first-time head injury. It is unclear whether they are appropriate for detecting brain injury in women survivors. Until IPV-specific brain injury screening tools are developed, frontline workers working with IPV survivors can use the existing tools, albeit with caution and only after careful consideration of the potentially harmful consequences of screening described above. Alternatively, a frontline worker can start by asking basic questions about physical violence, problems with memory, headaches, and changes in cognitive function.¹

Selected Screening Tools:

• HELPS Brain Injury Screening Tool²
• Ohio State University TBI Identification Method³
• Brain Injury Severity Assessment Interview⁴

Tools From Existing Toolkits:

• Heads UP!⁵
• Brief Screening for Possible Brain Injury⁶